DESCRIPTION (after the application): The traditional model of medical training places trainees in a particular environment for a period of time with the expectation that such activity will lead to clinical competence. Traditionally, training in neonatal resuscitation has been accomplished by assuming graduated responsibility in caring for real patients and participation in standardized courses such as the Neonatal Resuscitation Program of the American Academy of Pediatrics. Although historically accepted and universally utilized by physician and nursing training programs, there is little objective data that describes the impact of this training model upon actual practice. The applicant has developed a new model of training in neonatal resuscitation, NeoSim, that embodies many of the strengths of on-the-job training in the real delivery room and standardized courses (utilizing textbooks, lectures, skill stations, and objective tests) while minimizing the limitations associated with this traditional training model. The applicant seeks to answer a fundamental question regarding this high-fidelity simulation-based medical training program: Do the skills acquired within the simulated delivery room environment result in improved human performance and enhanced patient safety in the real delivery room? First, baseline data will be gathered on the performance and error rate of our neonatal resuscitation teams as they care for human neonates in the real delivery room. Next, all members of investigator teams will undergo NeoSim training in the simulated delivery room environment. This will be followed by evaluating the impact of this simulation-based training program upon practice in the real delivery room. Approximately four million births occur annually in the U.S. alone; of these, a large percentage require the presence of a team skilled in neonatal resuscitation. This work has the potential to impact the delivery of healthcare to hundreds of thousands of newborns and their mothers each year. Not only does this represent the first attempt to critically assess the impact of simulation-based training on human performance in a real medical domain, but it is also the only comprehensive high-fidelity simulation-based training program in pediatric medicine in the world.